Substance Use & Addiction Journal

This study investigated differences between completers and noncompleters of an intensive outpatient substance abuse treatment program to identify key predictors of attrition. Participants (n= 138) completed a comprehensive intake/assessment package that included the Addiction Severity Index as a precursor to participation in the program. Discriminant function analyses (DFA) suggested that ASI composite scores and severity ratings were not useful predictors. However, analysis of individual items was useful in identifying “red flags”; as predictors for treatment attrition. The subsequent DFA identified the following variables as significant predictors: Hispanic ethnicity, absence of a professional skill, shorter time since last hospitalization, cocaine or cannabis use in the last 30 days, total number of family members with drug problems, presence of emotional abuse in last 30 days, concern with family problems, and number of family group meetings that family members attended. These red flags can serve the important function of providing clinicians with enough information to intervene early with patients at risk for treatment dropout.

The relationship of temperament to different patterns and types of alcohol abuse has received much attention over the last decade in order to provide clues to matching patients optimally to treatment strategies. The purpose of this study was to examine the relationship of temperament with a number of relevant substance abuse characteristics in a substance abusing population. One hundred forty‐five male veterans were interviewed on their lifetime use of substances and on their psychiatric symptoms, problems associated with use, context, and family history of substance abuse. Subjects filled out the TPQ and the MPQ, which were subjected to factor analysis and revealed four factors: (1) Negative Affectivity/Impulsivity, (2) Positive Affectivity/Sociability, (3) Persistence/Achievement, and (4) Constraint. There was partial support for the hypotheses. Impulsivity was negatively correlated with age of onset and positively correlated with substance‐related problems and a family history of substance abuse. Subjects with a history of depression scored significantly lower on the Positive Affectivity/ Sociability factor than those who had not experienced a significant depression. Individuals who used alone scored lower on this factor than those who used in social contexts. The temperament factors of Persistence/Achievement and Constraint were, for the most part, unrelated to substance abuse.

Our purpose was to determine the frequency and predictors of quitting smoking among patients hospitalized on the medical services of a smoke‐free hospital All smokers admitted to the medical services of a single university teaching hospital were eligible and 129 patients were enrolled. A questionnaire detailing demographic information, stages of change, smoking behavior while hospitalized, and intention to remain abstinent on discharge was administered. The primary discharge diagnosis was obtained from the medical record. Patients were followed at 3‐ and 6‐month intervals for continuous abstinence, with expired carbon monoxide confirmation at 6 months. A total of 7% of smoking patients receiving usual medical care were continuously abstinent at 6 months. Of those who relapsed, 45% did so by the time of discharge, 18% within the first week, 20% between 1 week and 3 months, and 10% between 3 and 6 months after discharge. All patients who were abstinent at 6 months had been admitted for coronary artery disease (CAD). Nine of the 38 patients with CAD were abstinent, versus none of 93 with another diagnosis (p < .001). Smokers admitted to a smoke‐free hospital had a high rate of relapse, especially early after discharge. Patients admitted for CAD had a greater likelihood of successfully quitting. Designing hospital‐based smoking cessation interventions with a focus on early relapse prevention may help improve smoking cessation rates.

In order to evaluate the stages of change model as a predictor of abstinence among alcoholics, we examined abstinence rates at the end of treatment and at a 6‐month posttreatment follow‐up in 113 alcohol‐dependent subjects participating in two 12‐week, placebo‐controlled pharmacotherapy trials. Hierarchical logistic regression was used to examine the predictive validity of stages of change variables. At the end of treatment and at follow‐up, individuals with a higher predisposition toward action were more likely to be abstinent. Subjects who received an active medication (buspirone or fluoxetine) were more likely also to remain abstinent during the 6‐month posttreatment follow‐up. Scores on measures of precontemplation, contemplation, and maintenance failed to predict abstinence either at the end of treatment or at follow‐up. Although none of the stages of change measures were associated with treatment completion, married or cohabiting individuals were more likely to complete treatment. Despite that scores on the precontemplation, contemplation, and maintenance subscales were not associated with abstinence, a measure of readiness for action contributed significantly to the prediction model